The nature of the biomechanical disturbance and how it produces pain has not been stated. It implies that vertebral body fractures compromise the biomechanics of the affected region whereupon the resultant pain is biomechanical in nature, but no further explanation has been forthcoming. They remain post hoc explanations of how pain is relieved by vertebroplasty. However, no direct evidence of either if these mechanisms has been forthcoming. An alternative, or additional, explanation is that the heat generated by the cement upon injection coagulates nerve endings in the vertebral body that mediate the pain. The injection of cement into the vertebral body ostensibly stabilizes the fracture, and relieves pain by preventing micromovements at the fracture site. Although not expressly stated, this mechanism is implied by those who use vertebroplasty to treat the pain. One school implies that it is the fracture site itself that is the source of pain. Both are implied because neither has been outrightly articulated. More elusive is the mechanism of persistent pain following vertebral body fracture. That pain may be temporary, or it may persist.įor self-limiting pain, the mechanism is probably inflammation around the fracture site. These fractures may be asymptomatic, or the patient may report spinal pain in the region of the fracture. In younger individuals, they may occur as a result of trauma. Osteoporosis, Compression Fracture, pain, Diagnostic Block, Medial Branch IntroductionĬompression fractures of a lumbar or thoracic vertebral body are one of the complications of spinal osteoporosis. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies. In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies.Ĭonclusions. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. Proof of principle was provided by performing controlled diagnostic blocks in six patients. The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body. The problem is that if you have osteoporosis and low bone density, the Surgeon may judge you to be too high risk for this procedure which depends on the bones being strong enough to withstand the hardware placement.Objectives. The procedure does restrict some movement of the back, but it is a worthwhile option for someone who is suffering from chronic debilitating pain. Spinal fusion surgery involves using metal bolts to attach bone graft material between two vertebrae until the two bones naturally fuse together over time. Because this procedure is more invasive, it is typically a last resort for relieving back pain. This procedure involves fusing two vertebrae together to prevent them from moving, as the movement is what causes pain. The risk is low, especially when compared to the high success rate and relief the patient feels. X-Ray is used to ensure correct placement of needles and cement. Next another needle is placed into this cave and cement injected to fill the fractured bone and stop it from causing pain. Through this tunnel a small probe with an inflatable balloon on the tip is placed and the balloon inflated. In this procedure, a needle is placed into the fractured bone to create a tunnel. There are some surgical procedures that can be done to alleviate the pain associated with vertebral fracture.
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